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Beyond postpartum depression: posttraumatic stress-depressive response following childbirth


Although depression following childbirth is well recognized, much less is known about comorbid postpartum psychiatric conditions. Some women can endorse posttraumatic stress related to the childbirth experience accompanied by symptoms of depression. The objective of our study was to examine the nature of the comorbidity of symptoms of childbirth-related posttraumatic stress disorder (PTSD) and postpartum depression. We studied a sample of 685 women who were on average 3 months following childbirth and collected data about their mental health pertaining to PTSD, depression, general distress, and childbirth experience. The vast majority of women with elevated childbirth-related PTSD symptoms also endorsed elevated postpartum depression symptoms. Factor analysis revealed that symptoms of childbirth-related PTSD and postpartum depression loaded onto one single factor rather than two factors. Stepwise multi-nominal regression analysis revealed that childbirth stressors, including obstetric complications and peritraumatic distress in birth, predicted the likelihood of developing comorbid childbirth-related PTSD and postpartum depression, but not depression alone. The findings suggest that beyond postpartum depression, postpartum women suffer from a posttraumatic stress-depressive response in the wake of a traumatic childbirth experience. Increasing awareness in routine postpartum care about traumatic childbirth and its associated emotional sequela is warranted.

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The authors would like to thank Ms. Shannon Hennig for her generous support in initiating this research project. We also would like to thank Sabrina Chan for assisting with manuscript editing.

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Correspondence to Sharon Dekel.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Partners (Massachusetts General Hospital) Human Research Committee granted this study exemption.

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This study entailed an anonymous online survey and no personal identifiable information was collected. Participants were informed that by agreeing to complete the study survey, they are implying their consent to participate in the study.

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Dekel, S., Ein-Dor, T., Dishy, G.A. et al. Beyond postpartum depression: posttraumatic stress-depressive response following childbirth. Arch Womens Ment Health 23, 557–564 (2020).

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  • Posttraumatic stress
  • Postpartum depression
  • Traumatic childbirth
  • Factor analysis
  • PTSD